Evaluating Nurse Manager Strategies for Effective Implementation of the Fundamentals of Care.

Abstract

Introduction: The Fundamentals of Care (FoC) framework offers a person-centered, holistic approach to nursing care by emphasizing physical, psychosocial, and relational needs within therapeutic relationships. Despite growing recognition of its relevance, systematic implementation of the FoC model remains limited due to organizational, structural, and cultural barriers. Nurse managers (coordinators) play a pivotal leadership role in promoting and integrating FoC practices within clinical settings.

Objectives: To evaluate the strategies implemented by nurse managers in Italian hospitals to support the effective adoption of the FoC framework, and to explore their perceptions, knowledge, and leadership practices related to FoC.

Methods: A cross-sectional descriptive study was conducted using a validated questionnaire distributed to nurse managers with Organizational Function Assignments. A purposive sampling approach was used through national scientific associations (SIDMI and CNC). Descriptive, inferential, and multivariate statistical analyses were performed using SPSS v.26. Principal Component Analysis (PCA) was applied to identify latent dimensions of leadership practices.

Results: Out of 156 questionnaires received, 65 fully completed responses were analyzed. While most participants demonstrated basic knowledge of the FoC model (55.4%), only 16.9% reported having received specific training, and just 12.3% indicated institutional support for implementation. Key strategies perceived as effective included continuous staff education (65%) and regular team feedback (85%). Five principal components of leadership emerged from the PCA: empowerment, development, governance, visibility, and quality. Higher scores were associated with greater experience in the coordination role and specific training in FoC. However, systemic barriers and lack of structured support were commonly reported.

Conclusions: Nurse managers are key facilitators of FoC integration in hospital settings, primarily through relational and supportive leadership. Their ability to guide teams relies on adaptable leadership styles, focused on empowerment, education, and clinical presence. Nonetheless, broader institutional investment is needed to create conditions conducive to widespread and sustainable implementation of the FoC model.